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0 <br />P.D. Box 4208 <br />Sonora CA 95370 <br />Ca: 623541 A-Haz <br />Alitech Phone: 209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />MONITORING SYSTEM CERTIFICATION for VPH SYSTEMS71ail@aalltechpetro.com <br />www.ailtechpetro.com <br />A. Facility General Information <br />Facility Name: Costco # 1031 Manteca Date of Testing: Tuesday, August 21, 2012 <br />Facility Address: 2440 Daniel St., Manteca CA <br />Facility Contact Person: Julian Ochoa (Ser. Sta. Supervisor); Facility Phone: <br />LIA: San Jaoquin Health; Inspector: Thuy Tran. <br />Make/Model of Monitoring System: Veeder-Root TLS -350 <br />B. Inventory of Equipment Tested/Certified: <br />Tank ID: Regular 1 Tank <br />Tank ID: Regular 2 Tank <br />®In -Tank Gauging Probe. Model: Mag Plus <br />❑In -Tank Gauging Probe, Model: Mag Plus <br />®Tank Annular Space Sensor. Model: 794380-301 <br />RTank Annular Space Sensor. Model: 794380-301 <br />®Piping Sump Sensor(s). Model: 857080-112 <br />NPiping Sump Sensor(s). Model: 857080-112 <br />®Piping Sump Annular: Model: 794380-304 <br />[APiping Sump Annular: Model: 794380-304 <br />®Fill Sump Sensor(s). Model: 857080-112 <br />ZFill Sump Sensor(s). Model: 857080-112 <br />NFill Sump annular Model: 794380-304 <br />®Fill Sump annular Model 794380-304 <br />(Secondary Piping monitor Type: Vacuum <br />ESecondary Piping monitor Type: Vacuum <br />ZElecrtonic Line Leak Detector. Model: PLLD <br />ZElectronic Line Leak Detector. Model: PLLD <br />ZTank Overfill / High -Level Sensor. Model: V -R Audible <br />OTank Overfill / High -Level Sensor. Model: V -R Audible <br />® Fills ill Bucket Tested: (Vapor Bucket Failed) ®Pass ❑Fail <br />® Fillspill Bucket Tested: ®Pass ❑Fail <br />Tank ID: Premium Tank <br />Tank ID: <br />❑In -Tank Gauging Probe. Model: Mag Plus <br />El In -Tank Gauging Probe. Model: <br />®Tank Annular Space Sensor. Model: 794380-301 <br />❑Tank Annular Space Sensor. Model: <br />®Piping Sump Sensor(5). Model: 857080-312 <br />El Piping Sump Sensor(s). Model: <br />®Piping Sump Annular: Model: 794380-304 <br />❑Piping Sump Annular: Model' <br />®Fill Sump Sensor(s). Model: 857080-112 <br />❑Fill Sump Sensor(5). Model: <br />ZFill Sump annular Model: 794380-304 <br />❑Fill Sump annular Model: <br />ZSecondary Piping monitor Type: Vacuum <br />❑Secondary Piping monitor Type: <br />ZElectronic Line Leak Detector. Model: PLLD <br />❑ Line Leak Detector. Model: <br />®Tank Overfill / High -Level Sensor. Model: V -R Audible <br />❑Tank Overfill/ High -Level Sensor. Model: <br />❑ Fills ill Bucket Tested: ®Pass ❑Fail <br />❑ Fills ill Bucket Tested: ❑Pass ❑Fail <br />Dispenser ID: 1 &2 ® Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 3&4 N Sump: ®Dry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />❑Dispenser Containment Sensor(s). Model: 794380-323 <br />® UDC Annular sensor. Model: 794380-304 <br />❑* UDC Annular sensor. Model: 794380-304 <br />®Shear Valves) (Functional test) <br />MShear Valve(s) (Functional test) <br />Dispenser ID: 5&6 ® Sump: (Dry ❑Water ❑Product <br />Dispenser ID: 7&8 ® Sump: NDry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />UDC Annular sensor. Model: 794380-304 <br />® UDC Annular sensor. Model: 794380-304 <br />ZShear Valve(s) (Functional test) <br />®Shear Valve(s) (Functional test) <br />Dispenser ID: 9&10 ❑ Sump: ZDry ❑Water ❑Product <br />Dispenser ID: 11&12 ® Sump: ZDry ❑Water ❑Product <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />❑Dispenser Containment Sensor(s). Model: 794380-323 <br />❑ UDC Annular sensor. Model: 794380-304 <br />❑ UDC Annular sensor. Model: 794380-304 <br />❑Shear Valve(s) (Functional test) <br />®Shear Valves) (Functional test) <br />Dispenser ID: 13&14 M Sump: ®Dry ❑Water ❑Product <br />Dispenser ID: 15&16 ❑ Sump: ®Dry ❑Water E] Product <br />ZDispenser Containment Sensor(s). Model: 794380-323 <br />ZDispenser Containment Sensor(s). Model: 794380-323 <br />® UDC Annular sensor. Model: 794380-304 <br />❑ UDC Annular sensor. Model: 794380-304 <br />®Shear Valves) (Functional test) <br />❑Shear Valves) (Functional test) <br />Dispenser ID: Vent Stack Transition Sump <br />Dispenser ID: ❑ Sump: ❑Dry ❑Water [—]Product <br />❑ Sump: ®dry ❑Water ❑Product <br />F-1 Dispenser Containment Sensor(s). Model: <br />®Dispenser Containment Sensor(s). Model: 794380-323 <br />❑ UDC Annular sensor. Model' <br />® UDC Annular sensor. Model: 794380-304 <br />* Sensor installed but not operating properly. <br />Technician: <br />Certification: Veeder-Root B36878, Level 4 <br />ICC UST Service Technician # 8146912 -UT <br />Date: 8/21/12 <br />